Citizen centred healthcare reform needs to be ‘digital’, doesn’t it?

Citizen centred healthcare is part of a shift in focus which has drawn increasing interest in recent years, highlighting the importance of incorporating citizens’ needs and perspectives into care delivery. The citizen’s engagement with their care is now considered a key part of patient-centred healthcare.

Incorporation of health solutions addressing the Department of Health Digital First initiatives addressing patient engagement in particular, those identified initially with long-term chronic conditions as a first step, with delivery of health engagement solution that can reach the patients personal care circle, would provide a first significant foundation for service transformation to a patient centric service model.

As has been acknowledged in a recent Guardian article,

“Families are the biggest providers of care, yet carers can find themselves cut out of decision-making and bounced between bureaucracies.

If you care for someone and they need support, you don’t really care whether it is the NHS, a local council or nearby mental health services that provides it – all that matters is that it is the right support, on time, from a caring and well-trained professional

Better integration can solve that problem because it leads to the NHS, local councils and mental health services working better as a unit rather than as three separate entities. When services are integrated, all that matters is making sure that older, ill and disabled people and their families get continuous care regardless of their circumstances.”

The objective of integrated care is reflected in the NHS England mandate:

“An NHS for everyone, regardless of income, location, age, gender ethnicity or any other characteristic. Yet across these groups there are still too many long-standing and unjustifiable inequalities in access to services, in quality of care and in health outcomes. The NHS England Board has specific legal duties to tackle health inequalities and advance equality”.

“The Board’s objective is to achieve a significant increase in the use of technology to help people manage their health and care”.

Presently technology investments tend to be focused on filling gaps in operational information capability, electronic patient records investments being an example of note. Whilst these will make a positive impact on the operational efficiency of service providers, the focus of this investment is presently too narrow to facilitate radical transformation to a new service delivery model that better engages and supports citizens and importantly, those with long-term chronic conditions and their family members and friends operating in a carer role.


There is a large body of evidence that highlights “care closer to home” delivered by the provision of better engagement of citizen with their family and friends (carers) is fundamental to service transformation, at a scale sufficient to make a significant and demonstrable contribution across the health and social care “Quality, Innovation, Productivity and Prevention (QIPP)” agenda.

The Guardian article goes on to highlight:

“That in the worst cases, failing to support families can push them to breaking point and result in hospitals admitting both the carer and the older or disabled person. This situation is unacceptable but it is also preventable”

in a recent Carers UK survey,

“almost two-thirds of carers supporting someone after a hospital discharge said they had either been consulted late or not at all, and one in three carers caring for someone recently admitted to hospital in an emergency said that it could have been prevented if they had had more support at home”

Making The Case

This highlights one of the more significant well-being benefits to be derived from better citizen / carer engagement that can also make a very significant contribution for reductions in the cost of healthcare, by reducing for example the number of avoidable hospital admissions, a theme explored in a King’s Fund paper on (Dec 2010), which exposed a number of factors that were found to be associated with increased rates of admission, and therefore important considerations when targeting interventions with the objective of reducing avoidable admissions.

The Kings Fund report classified the consideration into the following categories:

Age; Social Deprivation; Morbidity Levels; Area of Residence;
Ethnicity; and Environmental Factors

The report recommendations that,

“Policy-makers should consider the impact of socio-economic deprivation and other socio-demographic factors when designing policy around admission rates”

The fact is these factors are equally important considerations for citizen / carer engagement.

Suggested approaches put forward by the Kings Fund paper towards identifying high risk groups focus on internal business intelligence (BI) approaches utilising the clinical knowledge base, notable threshold modelling and predictive modelling.

BI technology and capability investments are making important contributions to the remodelling of service delivery models with demonstrable progress already achieved towards Evidence-Based Health Care (EBHC), Pay for Performance (P4P), Diagnosis-Related Groups (DRG) of note, some of which are positively impacting costs through reductions in things like hospital admission rates.

The addition of a citizen centric dimension, with additional socio-economic deprivation and socio-demographic data inputs derived from engagement of citizens, their care circle and other third sector providers, charities and special interest local and national groups would greatly enhance the value of BI investments to provide a much stronger platform upon which service transformation decision making would be established.

Digital Citizen Centred Healthcare

Emergence of web and mobile app based technologies has provided a wide range of options for securing patient / citizen engagement with public services. Today a search of the Apple App Store for “NHS” will return a listing of 176 apps for the iPhone, and 44 for the iPad device, the Google Play App Store returns 155 apps for the IOS platform, some are the same apps, and some are not, a search on either App Store for “healthcare” generates a less than helpful greater return of results.

It is unfortunate however that the range of apps is beguiling, some are location or service provider specific, some relate to general information on services, some are condition specific, some are provider specific etc. etc., and makes for quite a wide and varied experience for the end user, with a wide variation in approaches addressing accessibility, presentation and most importantly privacy.

On the Internet the experience is just as varied and beguiling, and from an engagement perspective, services such as mainstream social networking platforms (Facebook, Twitter, LinkedIn etc.) are not able to offer the assurances on privacy and data protection required to underpin and maintain engagement, sufficiently to be utilised as collaboration tools on healthcare, beyond generalised messaging.

Exploiting Technology for Better Engagement

Unquestionably technology, and in particular web and mobile services are key enablers for engagement, service transformation, and the ability to offer a “choice for method” for engagement has some value. There is however merit in the unification of approaches, if the full benefits of engagement via mobile, internet and social networking services are truly to be secured, and at scale, quickly and for the long-term.

For this to happen, a digital citizen centred focus needs to be incorporated into technology investment considerations. This is important not only from the perspective of ensuring technology investment decisions are appropriate and aligned where necessary to engagement aims, but that also requirements concerning data protection and information governance, necessary to secure and maintain citizen and carer engagement, are also addressed appropriately going forward.

To be successful, any technology solution must also be highly scalable, flexible enough to support multiple healthcare transformation initiatives across multiple organisations and communities, seamlessly integrate multiple partners (interoperable), low cost and leave the public health and care providers in control.

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